Neural injury by frontal approach of external ventricular drainage in stroke patients

No study on the characteristics of injury of neural tracts following external ventricular drainage (EVD) in a large number of consecutive patients following EVD has been reported. In this study, using diffusion tensor tractography (DTT), we attempted to investigate the characteristics of injury of neural tracts associated with EVD using a frontal approach in stroke patients.

We recruited 43 consecutive hemorrhagic stroke patients with a history of EVD using a frontal approach. Five neural tracts were reconstructed [corticospinal-tract (CST), corticoreticular-pathway (CRP), arcuate-fasciculus (AF), cingulum, and superior-longitudinal-fasciculus (SLF)].

Among five neural tracts, neural injury by EVD was observed on only two neural tracts (the CRP and the cingulum): CRP-seven (16.3%, five patients-partial tearing and two patients-complete discontinuation) of 43 patients and cingulum-eight (18.6%, eight patients-complete discontinuation of the anterior portion of the cingulum) of 43 patients.

It appears that neural injury occurred in a considerable number of patients who underwent EVD; therefore, conduct of further studies on measures to prevent or minimize neural injury by EVD should be encouraged.